A Vein Effort

Scientists at New York-Presbyterian Hospital's Weill Cornell Medical Center have issued two reports that provide new information about male infertility, granting infertile couples better expectations for the future. One report reveals that a common cause of male fertility issues, varicose veins in the scrotum, or varicoceles, reduce levels of the male hormone testosterone. The other report proves that after surgery to remove the varicoceles, testosterone levels go back to normal and with it a man's fertility.

Dr. Marc Goldstein, Professor of Urology and Reproductive Medicine at Weill Cornell Medical College and an attending urologist at New York-Presbyterian/Weill Cornell is the author for both of these studies. The professor gave over the results of these trials at the annual 2007 meeting of the American Society for Reproductive Medicine (ASRM) located in Washington, D.C. During the course of the convention, Goldstein received the Howard and Georgeanna Jones Life Time Achievement Award.

Microsurgical Technique

Dr. Goldstein has earned high regard as an innovator for urological surgery techniques. It was his microsurgical procedure that was adopted as the accepted method for treating and removing varicoceles. In his address, Goldstein commented, "People often forget or often don't realize that the testes have two purposes. One is the production of the sex cells (sperm), and the other is to produce testosterone."

The studies were based on the hypothesis that varicoceles might cause a large drop in testosterone levels. Once Goldstein was able to prove this part of the theory, his next step was to discover whether the removal of varicoceles might restore normal testosterone levels. Goldstein made a significant discovery: testosterone levels rose as much as 100% after surgery was performed in 2/3 of the participants.

When testosterone levels fall, men can experience the female equivalent of menopause, known as andropause. Andropause can be responsible for many symptoms including reduced libido, erectile dysfunction, declining muscle strength, fatigue, and depression. Just as in menopause, andropausal men can end up with osteopenia and osteoporosis.

Enlarged Veins

The tendency for varicose veins, including varicoceles is hereditary and occurs in up to 15% of all men. As the veins enlarge, they become wrapped around the testes, blocking testosterone production. Varicoceles can also lead to reduced sperm counts and sperm of poor quality.

Some 35% of primary infertility, or first pregnancy attempt, and 80% of conception failures after previous pregnancies (secondary infertility) are caused by varicoceles. While doctors don't screen patients for varicoceles during routine visits, the varicose veins tend to develop during puberty and can be caught early on.